Capsular contracture

Last revised by Ammar Haouimi on 1 May 2024

Capsular contractures are a potential complication of a breast implant and refer to a tightening and hardening of the capsule that surrounds a breast implant. It is a condition that can distort the shape and cause pain in the augmented breast. It seems to be the most common complication post-breast augmentation surgery (~17.5%).



The grade of contracture has been classified by Baker as following:

  • grade I: the breast is soft (but not the capsule, as the capsule is contracted)

  • grade II: the breast looks normal but is rather hard to touch

  • grade III: the breast is hard, there is some distortion due to contracture and the breast becomes rounded, or the implant is generally moved upwards

  • grade IV: is similar to grade III but with progressive hardening of the capsule and greater distortion in shape

Capsular contracture (CC) is a multifactorial condition, for which multiple solutions have been proposed, including alternative implant placement alternative filler material within the shell of the implant and surface texture of the implant.

Radiographic features


May show thickening of the echogenic fibrous capsule with an increased number of radial folds. An increased anterior-posterior diameter may be seen 12.

Ultrasound grading

Zuniga et al16 have proposed an ultrasound grading to assist in the objective assessment of CC.

  • grade I: capsule thickness < or = to 0.5 mm, absence of wrinkles and no shape deformity

  • grade II: capsule thickness > 0.5 and <1.5 mm, absence of wrinkles and no shape deformity

  • grade III: capsule thickness > or = to 1.5 mm with abnormal wrinkles and no shape deformity

  • grade IV: capsule thickness > or = to 1.5 mm, with abnormal wrinkles and evidence of shape deformity

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